episodes (recurrent symptoms) when distinguish-
ing Ménière’s disease from other forms of vestibu-
lar dysfunction. These are
- VERTIGO(sensation that the person or the envi-
ronment is spinning or whirling), often with
NAUSEAand vomiting, and sometimes debilitat-
ing loss of balance - TINNITUS(rushing or roaring sound) in one ear,
often worse during vertigo attacks - hearing loss in one ear that returns with the
conclusion of each episode of symptoms
though progressively worsens with multiple
episodes - sensation of fullness or congestion in one ear
Symptoms may last 20 minutes to several
hours, and may fluctuate within, as well as vary
among, episodes. Doctors disagree on whether all
four symptoms must exist to constitute Ménière’s
disease, and whether symptoms other than vertigo
must involve only one ear. Diagnosis is primarily
by exclusion, with findings to rule out other
vestibular dysfunctions and causes. Diagnostic
tests and procedures often include
- OTOSCOPY (visualization of the auditory canal
and middle ear with a lighted instrument) - complete blood count (CBC) to look for signs of
infection or immune response - COMPUTED TOMOGRAPHY (CT) SCAN or MAGNETIC
RESONANCE IMAGING(MRI) to rule out tumors and
structural problems - NEUROLOGIC EXAMINATION to rule out ACOUSTIC
NEUROMA or disorders affecting the CRANIAL
NERVES - AUDIOLOGIC ASSESSMENTto evaluate hearing loss
Findings that fail to support any other diagno-
sis, in combination with the four cardinal symp-
toms, point to a diagnosis of Ménière’s disease.
Treatment Options and Outlook
Treatment largely focuses on relieving symptoms
and varies depending on the relief various efforts
provide. Common treatments may include antin-
ausea medications, anticholinergic medications,
ANTIHISTAMINE MEDICATIONS, and scopolamine to
reduce the vertigo. When the vertigo is such that
it prohibits the activities of living for an extended
time, surgically cutting the vestibular NERVEends
the nerve messages the labyrinth sends to the
BRAIN yet preserves hearing. When vertigo is
severe and hearing loss is complete, labyrinthec-
tomy becomes a treatment option. The otolaryn-
gologist may surgically remove the labyrinth or
instill a DRUG, such as the antibiotic gentamicin,
into the inner ear that chemically destroys the
NERVEendings in the labyrinth.
The outlook for people who have Ménière’s
disease is variable and unpredictable. About 20
percent have only one attack; typically there are
few long-term consequences when this is the case,
though some people experience mild permanent
hearing loss. About 40 percent have recurrent
attacks, sometimes years apart, that medical treat-
ments effectively mitigate. Hearing loss tends to
worsen with each episode of symptoms, however,
and can become profound (complete) in the
affected ear. Another 20 percent have frequent
and debilitating attacks that do not respond to
medical treatments. For these people, Ménière’s
disease significantly interferes with QUALITY OF LIFE
and often produces moderate to severe hearing
loss over a relatively short period of time. The
remaining 20 percent of people who have
Ménière’s disease fall along the continuum.
The most favorable improvement for those who
have repeated episodes of symptoms is with ver-
tigo, which seems to go away roughly 10 years
after diagnosis in about 70 percent of people. Doc-
tors have no explanation for this; though medical
treatments can lessen the severity of vertigo dur-
ing attacks, they do not appear to influence this
10-year resolution marker.Risk Factors and Preventive Measures
There are no known measures to prevent Ménière’s
disease from developing in the first place. Lifestyle
factors appear to influence the return and severity
of symptoms in many people who have the condi-
tion, though researchers have yet to establish
definitive connections. These factors include the
amount of sodium in the diet, fluid consumption
and balance, smoking, stress, and certain food trig-
gers. Many people find that restricting dietary
sodium and limiting fluid intake reduce the fre-34 The Ear, Nose, Mouth and Throat